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Medicaid School-Based Services

School-based services are health-related and rehabilitative services provided to children with disabilities who receive services under the Individuals with Disabilities Education Act (IDEA).  These services are provided by school districts, and charter schools and are considered medically necessary for children to participate in their educational program. 

School districts and charter schools that enroll as Medicaid providers can receive reimbursement for school-based services provided that:

  • The child is eligible for Medicaid
  • Each service is specifically identified on an Individualized Education Program (IEP)
  • Services are medically necessary for a child to benefit from their educational program

Parents/guardians are notified that the school district or charter school intends to bill Medicaid for the child’s services, and parents have the opportunity to sign a release form to have the school bill Medicaid directly for services rendered.

If schools do not wish to receive Medicaid reimbursement, they are still required to provide those services mandated by the IDEA.  If a child loses Medicaid, the services that they receive through their IEP should not be affected. 

Services Available:

Services are determined by your child’s IEP/IFSP planning team, and must be referred by a physician or practitioner of the healing arts to determine that the services are medically necessary for Medicaid reimbursement.  To find out what services are available for your child, contact your local school district.

Contact Information:

Contact School-Based Medicaid staff by email

What's New

 

Enrolled school districts and charter schools may receive Medicaid reimbursement for rehabilitative and health related services provided to children.  School districts and charter schools may bill Medicaid for certain medically necessary services provided to Medicaid-eligible participants in the school, when recommended or referred by a physician or other practitioner of the healing arts (Physician’s Assistant, Nurse Practitioner, or Clinical Nurse Specialist).

On July 1, 2013, the services of Behavioral Intervention (BI) and Behavioral Consultation (BC) were new service options newly introduced to children receiving Medicaid School-Based Services.  BI promotes the student’s ability to participate in the educational environment through a consistent, assertive, and continuous intervention process.  BI also includes the development of replacement behaviors with the purpose to prevent or treat behavioral conditions of students who exhibit maladaptive behaviors.  This can include individual or group behavioral interventions.   BC assists other service professionals by consulting with the IEP team during the assessment process, performing advanced assessment, coordinating the implementation of the behavior implementation plan, and providing ongoing training to the Behavioral Interventionists and other team members.

Other services that enrolled school districts or charter schools can receive reimbursement for include:

  • Evaluations 
  • Medical Equipment and Supplies 
  • Nursing Services
  • Speech/Audiological Therapy and Evaluation
  • Occupational Therapy and Evaluation
  • Physical Therapy and Evaluation
  • Transportation Services
  • Interpretive Services
  • Psychotherapy
  • Psychological Evaluation
  • Psychosocial Rehabilitation
  • Personal Care Services
The Department of Education has developed training modules on the new and ongoing services for School-Based providers.  They can be found on the Idaho Training Clearinghouse Website.  Providers are strongly encouraged to use the training modules to become familiar with the new services.

If you have further questions, please feel free to contact School-Based Medicaid Staff at SchoolBasedServices@dhw.idaho.gov.